OREANDA-NEWS. June 20, 2013. Balancing the quality, accessibility and cost of care continues to be a struggle in healthcare. Progressive healthcare organizations, however, are taking a new approach that leverages smart automation and improved collaboration to help achieve this goal. McKesson gained seven new clients for its Clear Coverage™ decision support solution in fiscal year 2013, with an additional seven completing the implementation process.

New clients such as Molina Healthcare, Inc., have joined the growing number of companies realizing the benefits of Clear Coverage, which blends coverage, medical appropriateness and provider network intelligence into a single decision stream to support evidence-based, appropriate care delivery. At the same time, this approach has been shown to lower the administrative costs of utilization management by as much as 64%.

"We are expanding our use of Clear Coverage to eight states in the coming year," said Richard Sanchez, MD, senior vice president and chief medical officer at Molina. "Clear Coverage will help reduce our administrative costs and enable better collaboration with our providers while driving the consistent application of evidence-based medicine to increase the quality of care."

More than 20 organizations now license Clear Coverage, which incorporates the InterQual® evidence-based clinical content portfolio in a fully automated, interactive workflow to allow shared decision-making between payers and providers. Clear Coverage can help automate authorizations, direct patients to in-network service facilities, streamline often time-consuming requirements and tasks for office staff, and inform providers about eligibility and coverage specific to each patient.

"We all understand that reform means having to cut costs and increase quality, but the questions are how, where and what impact will those changes have? Utilization management processes are designed to ensure appropriate care, but because they are traditionally conducted via disparate , manual processes, it takes too long, costs too much, and ultimately inhibits the quality of care," said Matthew Zubiller, vice president of Decision Management at McKesson Health Solutions. "Our customers can use Clear Coverage to make the transition to next-generation utilization management, a prospective, exception-based process characterized by transparency, collaboration and efficiency. This means better health for our customers' businesses and their patients."

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